MRI快速检查法对致密型乳腺中乳腺癌筛查的应用价值

摘要

Objective To evaluate the application of abbreviated protocol (AP) of magnetic resonance imaging (MRI) in screening of breast cancer with dense breast tissue.Methods Total 478 patients with dense breast tissue,who had negative X-ray mammography (MG),underwent dynamic contrast-enhanced MRI (DCE-MRI).The AP MRI,which consisted of first postcontrast subtracted (FAST) and maximum-intensity projection (MIP),and full diagnostic protocol (FDP) MRI images were analyzed by Breast Imaging Reporting and Data System (BI-RADS).Among 478 patients the histopathological diagnosis was available in 39 cases (41 breast lesions).With pathological diagnosis as gold standard,the sensitivity,specificity,positive predictive value (PPV) and negative predictive value (NPV) of AP and FDP in breast cancer detection were evaluated.Results In 41 breast lesions there were 16 malignant lesions and 25 benign lesions.FDP detected all 16 malignant lesions,including 9 cases of ductal carcinoma in situ,6 cases of invasive ductal carcinoma and 1 case of mucinous carcinoma;AP detected 15 out of 16 cases of breast cancer.The sensitivity of FDP and AP in detection of breast malignant lesions was 16/16 and 15/16,respectively (x2 =0.725,P =0.224).The specificity of FDP and AP was 92％ (23/25) and 76％ (19/25),respectively (x2 =6.327,P =0.012).Conclusion For women with dense breast tissue AP of MRI can be used in early screening of breast cancer.%目的 了解MRI快速检查法对致密型乳腺中乳腺癌的筛查情况.方法 2011年1月至2015年12月对478例乳腺X线照相术筛查结果阴性的致密型乳腺患者行磁共振动态增强检查,快速检查方法仅读取首次增强减影及最大密度投影图像,常规检查法(FDP)读取所有动态增强图像,根据乳腺影像报告和数据系统标准各自做出诊断,对其中39例经病理检查证实乳腺病变患者回顾性分析,计算MRI快速检查法和FDP在致密型乳腺中对乳腺癌检出的敏感性、特异性、阳性预测值及阴性预测值,比较两种方法对乳腺癌的诊断准确性.结果 39例乳腺病变患者共检出41个病灶,其中恶性16例、16个病灶,分别为导管原位癌9例、浸润性导管癌6例、黏液癌1例;良性23例、25个病灶,分别为纤维瘤11例、乳腺增生6例(8个病灶)、导管内乳头状瘤2例、囊肿3例、肉芽肿1例.16例乳腺癌中快速检查法检出15例、FDP检出16例;25个良性病灶中FDP诊断正确23个、快速检查法诊断正确19个.两种方法的敏感性分别为15/16与16/16,差异无统计学意义(x2=0.725,P=0.224);特异性分别为76％(19/25)与92％(23/25),差异有统计学意义(x2=6.327,P=0.012).结论 MRI快速检查法能早期检出高致密型乳腺的乳腺癌.